Photos by Alan Hawes

In 1999, South Carolina ranked first in the nation in the number of deaths due to stroke and second in deaths from all cardiovascular diseases, including heart attacks and kidney disease. In the same year the Robert Wood Johnson Foundation, through its Local Funding Partnerships program, awarded a four-year, $285,000 grant to a statewide nonprofit corporation called the Palmetto Project to expand a faith-based pilot program on heart disease and stroke prevention throughout the state. The program, called Heart & Soul, is now active in more than 250 churches across the state.

With just two full-time staff members, the program trains volunteers from participating congregations to take blood-pressure readings and detect high blood pressure, a precursor of heart disease, heart attacks, strokes, and kidney disease. Church members found to have high blood pressure are referred to physicians and supported by church programs in nutrition, exercise, prayer, and Bible study.

Since the program's founding, its volunteer teams have conducted over 172,000 blood-pressure screenings, identifying nearly 40 percent of participants as having high blood pressure. Surveys showed that the average blood pressure of a typical participant dropped 19 percent following diagnosis and participation in the church's programs, while more than 70 percent made important lifestyle changes resulting in increased physical activity, improved weight management, and better nutrition.

Since the program began, death rates for both strokes and heart attacks have declined statewide. Rates for African Americans have declined even more dramatically, in some instances slashing race disparities nearly in half.

Carrie Whipper, a 50-year-old wife and mother of two who lives in Charleston, is one of the program's coordinators. Not only does she help thousands of South Carolinians through the program, but the program helps her as well. Whipper belongs to the 36.6 percent of African-American women in this country with high blood pressure (36.7 percent of African-American males also have high blood pressure).

A Family Affair

Carrie Whipper was just 5 years old on that long-ago day in rural Georgia. She was playing out in the yard, her grandmother sitting on a chair watching. Suddenly and with no warning, her grandmother began vomiting. Whipper, now 50, remembers little of what followed, other than her brother and father rushing over to pick up her grandmother, chair and all, and carry her into the house. And the fact that she never saw her grandmother again.

Her grandmother had suffered a stroke, the victim of a dangerous family trait—hypertension, or high blood pressure. The family legacy has continued through the generations. Whipper's uncle died of a stroke when Whipper was 30, and her four siblings all have been diagnosed with high blood pressure, as has she. So the work Carrie Whipper does as a program coordinator for the Heart & Soul program in South Carolina means much more to her than would the typical 9-to-5 job.

Whipper travels the coastal region of the state training church volunteers to screen congregants for high blood pressure and provide encouragement and support for living a healthier life. But she views her role in a much larger framework: She's helping to change the state's dubious distinction of ranking first in the nation in deaths due to strokes, and second in all cardiovascular diseases, including heart attacks.

"With this job, I'm helping to protect the health of myself and so many, many other people," she says. "I feel that if we make the proper inroads, we'll change some old habits and extend the life expectancy of people."

A Surprise Finding

Although Carrie Whipper, project coordinator for South Carolina's Heart & Soul program, knew that hypertension ran on both sides of her family, her own diagnosis at age 45 during a routine physical came as a shock. Sure, she was about 20 pounds overweight, but she avoided fried foods, followed a low-fat, heart-healthy diet of vegetables, fruits, grains and healthy proteins, and walked most days during her lunch break. With the diagnosis, and hoping to avoid having to take medication to control her high blood pressure, she upped her walking and cut her portion sizes. It helped, but not enough, and today she takes two prescription drugs to control her blood pressure.

At least her blood pressure is controlled by medicine. National figures show that blood pressure remains high in about 26.2 percent of people with hypertension who take medication. Whipper sees that statistic firsthand. "If you conduct a screening of 25 people at a church, chances are you will find 12 to 15 who have been diagnosed as having high blood pressure, and eight or nine of those will have elevated pressure even though they are on medication," she says.

The church screenings are also invaluable for finding people who have no idea they even have hypertension, a silent disease that usually has no symptoms. For instance, one screening identified an adolescent boy with high blood pressure, someone who otherwise would have no reason to be tested.

No Children Playing

In her job as program coordinator for the South Carolina Heart & Soul program, Carrie Whipper travels 18 counties along the South Carolina coast, meeting with church members. During her drives, she's noticed a disturbing trend: On beautiful summer mornings, she can travel the 130 miles from Charleston to Marion County and never see a child playing out in the yard, or people gardening. She blames air conditioning, which keeps people confined to their houses instead of outside getting the kind of physical activity so important to heart health.

It's just one of many reasons for South Carolina's dismal heart-disease statistics. Whipper counts them off: stress, lack of proper rest, heavily salted food, improper nutrition, lack of physical activity and a lack of understanding from doctors about how to manage high blood pressure, coupled with a lack of understanding by patients of how to make healthier lifestyle changes. Obesity plays another major role in the development of hypertension, and nationally 60.7 percent of African-American adult men and 77.3 percent of African-American adult women are either overweight or obese.

Whipper hopes to chip away at those statistics through the state's churches. Heart & Soul targets churches because African Americans in South Carolina, as in many southern states, tend to identify with a church, which forms a significant part of their community network. Thus, Whipper and church volunteers have a large, captive audience to hear their messages.

"People are in the churches because they're trying to be obedient to something that is being told to them from a spiritual perspective," she says. "So if we talk about one's body and health, there is a greater likelihood that the same obedience will translate to the health care area." The program also helps congregants recognize that part of their commitment to living in obedience to God is taking good care of their bodies. Finally, their church provides a support network; it's always easier to make lifestyle changes when other people who share a common challenge encourage each other

Scales in the Bathroom

When Carrie Whipper introduces a new church to South Carolina's Heart & Soul program, she usually meets with members of a church's health-care committee, either alone or in conjunction with other churches. Each church gets free blood-pressure cuffs, as well as forms to track congregants' weight and blood pressure. They also get some simple tips to improve congregants' overall health, such as putting a scale in the church restrooms.

"A lot of people don't know their weight is changing," says Whipper, who found herself making use of the scale in her own church. "Monitoring your weight is an important health habit that can be done on a regular basis and does not require intervention or assistance from a health care provider." She also suggests a scale be moved into the social hall during church social events. "It's a visual reminder that encourages self correction," she says. "People will think about what they're putting on their plate and are thus encouraged eat less."

Whipper also suggests churches discourage carry-out food, except for needy, elderly and sick members, and that members of the church food committees join the health committee so they can learn to develop healthier meals.

One other suggestion: that churches designate all church property—including the parking lot—as a smoke-free zone. "For some people, it may be the only two hours during the entire week they go without lighting a cigarette," she says.

Her work doesn't end when the training is done. She keeps in contact with churches through a newsletter that features tips for incorporating long-term lifestyle changes such as physical movement, better nutrition, less sodium, smaller portion sizes, better disease detection, and prevention practice for all ages. Additionally, church volunteers are invited to attend quarterly meetings to receive ongoing support, information and materials, where physicians and other health-care providers present information on a wide range of topics related to high blood pressure.

"There's a six-year difference in the life expectancy of African-Americans and non-African-Americans in this country, and we have to recognize that our lifestyle plays a significant role in that difference," she says. "What we are doing with Heart & Soul is just one small thing to change it."